The vertebral body fracture in osteoporosis: restoration of height using percutaneous vertebroplasty

Abstract

Background and purpose: Percutaneous vertebroplasty is an effective tool for the relief of pain caused by osteoporotic spine fractures. Our purpose is to evaluate this technique and its effectiveness in restoring the height of such fractures.

Methods: Forty osteoporotic vertebral body fractures in 30 consecutive patients (24 female, six males; mean age, 70 years) were analyzed retrospectively, before and after percutaneous vertebroplasty, for changes in vertebral body height, kyphosis angle, and wedge angle. The ages of the fractures range from 1 to 5 months.

Results: Percutaneous vertebroplasty improved the pretreatment height of compression fractures in these patients by a mean of 47.6% (P < .001), with only 15% showing no improvement. These figures compare favorably with published results for kyphoplasty (47% mean improvement in height in 70% of fractures; no improvement in 30% of fractures). In addition, we achieved a mean improvement in kyphosis angle of 6 degrees and an improvement in the wedge angle of 3.5 degrees (as compared with published results for kyphoplasty of 7.4 and 4.3 degrees , respectively; P < .001).

Conclusion: Percutaneous vertebroplasty should be viewed not only as a pain-relieving procedure, but also an effective method for improving vertebral body height, kyphosis angle, and wedge angle.

Fig 1.

Diagrammatic representation of lateral views of the spine and spinal fracture, pre- and post-vertebroplasty, are represented (1 indicates height of the control “normal” vertebral body; 2, height of the vertebral body pre- and postvertebroplasty; 3, kyphosis angle as according to the method of Cobb, as described by Teng et al [11]; 4, wedge angle as described by Teng et al [11]).

Fig 2.

Height improvement with prone positioning and vertebroplasty. A, Prevertebroplasty, T-12 osteoporotic fracture, with subtle anterior vertebral body cystic cavity, prone position, lateral (1). Midvertebral height of the fracture is compared with the adjacent normal appearing vertebral body height (2). B, Postpercutaneous vertebroplasty, prone, lateral, with improvement in height. The improvement in height by using the method of Leiberman et al, is approximately 30%. The improvements of the wedge angle and kyphosis angle, by using the method of Teng et al are eight and 7°, respectively.